Evidence indicates that up to 44% of otherwise healthy adult
Americans suffer from heartburn at least once a month, which parallels closely
with the previously reported 36%. Approximately 7% of the population experience
heartburn as often as once a day. It has been estimated that approximately 2% of
the adult population suffers from GERD, based on objective measures such as
endoscopic or histological examinations. The incidence of GERD increases
markedly after the age of 40, and it is not uncommon for patients experiencing
symptoms to wait years before seeking medical treatment.
- 1. What is GERD?
- GERD stands for Gastroesophageal
Reflux Disease.
Gastroesophageal reflux describes a backflow of acid from the stomach into
the swallowing tube or esophagus. This acid can irritate and sometimes
damage the delicate lining on the inside of the esophagus. Almost everyone
experiences gastroesophageal reflux at some time. The usual symptom is
heartburn, an uncomfortable burning sensation behind the breastbone, most
commonly occurring after a meal. In some individuals this reflux is frequent
or severe enough to cause more significant problems, that is a disease.
Thus, gastroesophageal reflux disease is a clinical condition that
occurs when reflux of stomach acid into the esophagus is severe enough to
impact the patient’s life and/or damage the esophagus.
- 2. I have never heard of GERD. Is it a new disease?
- No. GERD has probably been around as long as heartburn. The term is
relatively new (about 20 years), however, and has really come into common
usage over the past few years. GERD is often called "reflux,"
"reflux esophagitis," or sometimes even "hiatus hernia"
(although hiatus hernia is a specific diagnosis that may or may not have
anything to do with GERD). GERD is the preferred term because it accurately
describes the problem - reflux of stomach acid up into the esophagus where
it can produce symptoms and sometimes damage. Many patients and health care
professionals are not familiar with GERD and its potential consequences, and
thus may not have heard the term previously.
- 3. What are some symptoms of GERD?
- The four major symptoms of GERD are:
- Heartburn (uncomfortable, rising, burning sensation behind the
breastbone).
- Regurgitation of gastric acid or sour contents into the mouth.
- Difficult and/or painful swallowing.
- Chest pain.
Heartburn is the most common symptom of GERD. In some patients it may be
accompanied by other GERD symptoms, such as regurgitation of gastric
contents into the mouth, chest pain and difficulty swallowing. Pulmonary
manifestations, such as asthma, coughing, or intermittent wheezing and vocal
cord inflammation with hoarseness, occur in some GERD patients.
In addition, acid can be regurgitated into the lungs in some GERD
patients, causing wheezing or cough. Acid refluxed into the throat can cause
sore throat. If acid reaches the mouth, it can dissolve enamel of the teeth.
- 4. How do people get GERD? What causes GERD?
- GERD is caused by reflux of stomach acid into the esophagus. In most
patients this is due to a transient relaxation of the “gate” or
sphincter that keeps the lower end of the esophagus closed when a person is
not swallowing food or liquids. This transient relaxation happens a few
times each day in people without GERD. Why it happens more frequently in
GERD patients isn’t known. The esophagus is not able to cope with acid as
well as the stomach and is easily injured. It's the acid refluxing into the
esophagus that produces the symptoms and potentially damages the esophagus.
- 5. How many people are afflicted with GERD?
- Recent statistics from the US Department of Health and Human Services
indicate that about seven (7) million people in the US alone suffer from
GERD.
(Source: Digestive Diseases in the United States: Epidemiology and
Impact, National Digestive Diseases Data Working Group, James E. Everhart,
MD, MPH, Editor, US Department of Health and Human Services, Public Health
Service, National Institutes of Health, NIH Publication No. 94-1447, May
1994)
- 6. Who is afflicted with GERD?
- GERD afflicts people of every socioeconomic class, ethnic group and age.
However, the incidence does seem to increase quite dramatically above the
age of 40. Greater than 50 percent of those afflicted with GERD are between
the ages of 45-64 (both male and female).
- 7. Do children get GERD?
- Yes. GERD is most common in adults over age 40 but virtually anyone can
get GERD, even infants.
- 8. What is the difference between GERD and GORD?
- The British spelling of esophagus is oesophagus. Hence, GERD is GORD in
many European countries.
- 9. What is the difference between heartburn and GERD?
- GERD is a disease and heartburn is its most common symptom. Heartburn is
defined as a rising, burning sensation behind the breastbone caused by
reflux of stomach acid into the esophagus. Nearly everyone has or will
experience heartburn on occasion. Frequent heartburn that disrupts one's
lifestyle suggests the diagnosis of GERD.
- 10. What is the difference between GERD and a hiatus hernia?
- Hiatus hernia refers to dislocation of the stomach through the
"hiatus" of the diaphragm and into the chest. This is a common
condition that increases in frequency with age. It may or may not be
associated with GERD. When GERD is severe enough to be complicated by
erosive esophagitis, seen as breaks in the lining of the esophagus, a hiatus
hernia is usually present. However, most patients with a hiatus hernia do
not have GERD.
- 11. What is endoscopy and when is it used in GERD patients?
- Endoscopy is a diagnostic test wherein a thin, flexible tube is swallowed
by the patient to allow the physician to directly inspect the lining of the
upper gastrointestinal tract. This procedure can be used to identify
complications of GERD and to take small samples (biopsies) for further
analysis. GERD patients who have certain symptoms, such as difficulty in
swallowing or painful swallowing, should be considered for endoscopy.
Patients who fail to respond to therapy are also candidates for endoscopy.
Some physicians advocate endoscopy for all patients with long-standing GERD
in order to rule out Barrett's esophagus.
- 12. What are the complications of GERD?
- Only a minority of patients develop complications of GERD. These
complications include breaks in the lining of the esophagus (esophageal
erosions), esophageal ulcer, and narrowing of the esophagus (esophageal
stricture). In some patients, the normal esophageal lining or epithelium may
be replaced with abnormal (Barrett's) epithelium. This condition (Barrett's
esophagus) has been linked to cancer of the esophagus and must be carefully
watched. Lung (pulmonary) aspiration, asthma and inflammation of the vocal
cords or throat may also be caused by GERD.
- 13. What makes GERD symptoms worse?
- The major factor is meals. Meals stimulate the stomach to produce more
acid that can reflux up into the esophagus. In some patients, lying down or
taking certain medications can worsen acid reflux.
- 14. Does eating spicy food cause GERD or make GERD worse?
- Spicy foods do not cause GERD, although they do seem to worsen GERD
symptoms in some people. Food (in general) can make GERD worse. This is
because food fills the stomach and induces more transient relaxations of the
lower esophageal sphincter. In addition, all meals stimulate acid
production in the stomach to aid digestion and can increase reflux into the
esophagus in GERD sufferers. Any very large meal might be expected to
produce heartburn in some people. The spicy food story is so compelling,
however, that GERD sufferers often relate a spicy (or greasy) meal to their
symptoms. Often they are told to avoid certain foods whether or not these
foods have anything to do with their symptoms. In this way, many GERD
sufferers end up on a very restricted diet or end up blaming their symptoms
on dietary indiscretion. If avoiding spicy foods and/or other dietary advice
helps, that's great. If it doesn't, GERD sufferers shouldn't feel that they
are doing something wrong. They should seek medical advice on managing their
disease.
- 15. What about GERD and smoking?
- Smoking doesn't cause GERD and there is little evidence that smoking
significantly worsens GERD. Stopping smoking is a good idea anyway.
- 16. Do any medications make GERD worse?
- Yes. Medicines that delay emptying of acid from the stomach or that
increase acid backup into the esophagus can worsen GERD. If you have, or
suspect you have, GERD and you require medication for other conditions, you
should make sure you inform your doctor about all medications you are taking
including prescription and over-the-counter medications.
- 17. What should people with GERD avoid?
- GERD is a disease that is caused by gastric acid. However, certain foods
can trigger symptoms in some patients. Lying down after a meal, wearing
tight-fitting clothing, and even performing certain activities, such as
bending over, can also trigger symptoms in patients. A good way to identify
these "triggers" is to keep a diary of GERD symptoms noting when
they occur. If symptoms follow a pattern and occur after certain foods or
activities, these foods or activities should be avoided. A diary will also
help patients continue to enjoy those foods or activities that do not seem
to provoke symptoms, so that their lifestyle is not restricted
unnecessarily. Patients should review their symptoms with their doctor, who
can evaluate their condition and advise an appropriate treatment plan.
- 18. Can GERD cause cancer?
- Severe, long-standing GERD can damage the esophagus and cause a condition
known as Barrett's esophagus wherein the normal lining of the esophagus is
replaced by a lining more like that of the stomach or intestine. It is
thought that this replacement may be an attempt by the body to protect
itself from further injury by acid. The risk of esophageal cancer appears to
increase significantly in patients with Barrett's esophagus. The only way to
diagnose Barrett's esophagus is by endoscopy. Some studies suggest that
intensive treatment of Barrett's esophagus can reduce the amount of abnormal
lining in the esophagus. It is not yet clear whether such treatment will
prevent esophageal cancer in GERD patients, but this is under active
investigation.
- 19. Are there long-term consequences of GERD?
- Long-standing GERD can lead to damage of the esophagus. This damage
usually consists of breaks in the lining of the esophagus. In some cases
ulcers can develop. In some patients, such damage can result in scarring and
narrowing of the esophagus, making swallowing painful or difficult. A
condition called Barrett's esophagus is thought to result from long-standing
GERD in some patients. Barrett's esophagus is a risk factor for the
development of esophageal cancer. In some patients, acid backup caused by
GERD is thought to result in damage to the vocal cords or teeth and may even
cause asthma.
- 20. Is there relationship between GERD and asthma?
- Many investigators believe that there is a link between asthma and reflux
of stomach acid up into the throat and then down into the lungs in some
patients. It appears that some patients who suffer from asthma might benefit
from treatment of GERD. This is a topic of active research at the moment.
- 21. Can GERD cause inflammation of the throat?
- In some patients, acid can reflux into the throat causing inflammation of
the back of the throat which can lead to pharyngitis, or into the vocal
cords, which can lead to laryngitis and hoarseness. Although there are many
other causes for sore throat and laryngitis, GERD should be suspected in a
patient with chronic sore throat or other GERD symptoms or when no other
cause can be found.
- 22. Can GERD be cured?
- Unfortunately, GERD, in general, cannot be cured at present. In some
cases, it may be a temporary condition associated with a specific
aggravating factor such as pregnancy. In such cases, GERD will go away on
its own when the pregnancy has ended. In most cases GERD is a chronic
condition. However, it can be effectively managed with medications and
lifestyle modifications in almost everybody. In severe cases, surgery is an
option. Surgery does not cure the underlying problem, but wraps part of the
stomach around the lower end of the esophagus to help keep acid from getting
back up into the esophagus. A doctor can evaluate the condition and advise
on an appropriate treatment plan.
- 23. I think I have GERD. What should I do?
- See your doctor. Your doctor can establish the diagnosis and work with you
to get you symptom-free. Primary care and physicians of many specialties are
becoming increasingly familiar with GERD. Gastroenterologists and some
gastrointestinal surgeons are usually very familiar with GERD and its
treatment.
- 24. Where can I go for more information about GERD?
-
If you think you might have GERD - see your doctor who can determine if
you have GERD and, if so, can evaluate its severity. Additional information
is also available from the following organizations:
The American Gastroenterological Association (AGA)
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
301-654-2055
E-mail the AGA at info@gastro.org
AGA Home Page: http://www.gastro.org
The American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827-2260
301-263-9000
ACG Home Page: http://www.acg.gi.org/
